MEDIHELP FOUND IN CONTEMPT OF COURT AS JUDGE’S RULING UPHOLDS 6 YEAR OLD ZACH’S RIGHT TO CARE.
- Rare Diseases SA
- 12 minutes ago
- 4 min read
Pretoria, 31 October 2025 ~ The de Wet family and Rare Diseases South Africa (RDSA) welcome today’s High Court judgement delivered by Swanepoel J in the Gauteng Division, Pretoria, which declares Medihelp Medical Scheme in contempt of court and compels immediate compliance with an earlier order to fund prescribed minimum benefit (PMB) care for four-year-old Zachary de Wet, who lives with Hunter’s syndrome (MPS II).
This ruling follows years of litigation, during which the Court had already confirmed that MPS II is a PMB condition under category 901K and that Zachary’s PMB care includes Elaprase® enzyme replacement therapy and all associated medical interventions prescribed by his treating clinicians.
CONTEMPT FINDING AND ENFORCEMENT
The Court states it has “no doubt” Medihelp acted mala fide in refusing to fund Elaprase and the broader MPS II care pathway, and declares the scheme in contempt of the 26 August 2022 Millar order, with Judge Swanepoel stating: “I have no doubt that the applicant has taken the view that it will not fund treatment for Zachary's condition, despite having been ordered to do so, and that its conduct is mala fide.”
The Court authorises strong enforcement, including a potential writ for the immediate arrest of the scheme’s Principal Officer and punitive costs, should non-compliance continue. Judge Swanepoel stated: “It is required of all persons to comply with court orders until they are varied or discharged, and it is for the Courts to jealously guard against defiance of its orders. In my view the applicant's conduct is deserving of punishment.”
PMB RIGHTS APPLY TO RARE AND EXPENSIVE CARE
The Court reiterates that PMBs must be funded in full, quoting Regulation 8(1) which requires medical schemes to pay “in full for the diagnosis, treatment and care costs” of PMB conditions. Plan limits, administrative hurdles, or the scheme’s internal solvency arguments do not displace PMB obligations.
In a strongly worded ruling, the Court reaffirmed that Elaprase®, the only enzyme replacement therapy for MPS II, constitutes PMB-level care, and that a medical scheme cannot evade its obligations on technical grounds. The judgment warns against what the Court described as a “cynical approach” that prioritizes solvency arguments over the life and dignity of a child.
Justice Swanepoel ordered Medihelp to immediately comply with the original 2022 Millar judgment which recognized MPS II as a PMB condition and to fund all associated medical interventions prescribed by Zachary’s treating doctors, including therapies and care services such as physiotherapy, speech, and occupational therapy.
A MOTHER’S RELIEF AND A COMMUNITY’S HOPE
Speaking after the judgment, Jacques and Michaney, Zach’s parents, expressed relief and gratitude: “For more than four years, we have not only had to struggle daily to ensure Zach’s medical needs were met, but also have had the emotional toll of fighting in court for him to access that he is entitled too.
We have been loyal, paying members of Medihelp for more than 15 years, and this process has felt like absolute abandonment. When we have needed them most, they left us having to resort to legal action, to get our little boy the care he deserves. It has felt like a very personal attack from our scheme on its most vulnerable members.
To have vindication today means we can hopefully move forward, and focus on what really matters, and that is Zach getting access to the care and support that he needs.”
WATERSHED MOMENT
RDSA CEO Kelly du Plessis emphasized the broader impact of the decision:
“This ruling sends a clear message; rare disease patients are entitled to equitable care under South African law. Medical schemes cannot selectively interpret the PMB framework to the detriment of patients. It also reinforces that access to life-saving treatment is a constitutional matter tied to dignity, equality, and the right to health.”
The judgment represents a major precedent for the estimated 1 in 15 South Africans living with a rare disease, many of whom face systemic barriers to accessing approved treatments despite their inclusion under the PMB framework.
A CALL FOR SYSTEMIC CHANGE
While the ruling addresses Zachary’s immediate case, it highlights a recurring pattern across medical schemes where rare disease treatments are denied on cost or administrative grounds. RDSA calls on policymakers, funders, and regulators, including the Council for Medical Schemes (CMS) and National Department of Health, to ensure consistent interpretation and enforcement of PMB obligations for rare diseases, and to accelerate the adoption of a National Rare Disease Strategy.
________________________________________________
About Rare Diseases South Africa NPC
Rare Diseases South Africa NPC fights to have rare diseases and congenital disorders recognized and treated.
By connecting patients, families and patient groups, as well as by bringing together all stakeholders and mobilizing the South African rare disease community, Rare Diseases South Africa strengthens the patient voice and shapes research, policies and patient services.
Improving quality of life takes advocacy, support for research and medicine development, facilitating networking amongst patient groups and caregivers, raising general awareness with key stakeholders and the broader community and providing a platform for key discussions when it comes to inclusive healthcare.
For more information, visit www.rarediseases.co.za
_______________________________________________
LINKS TO DOCUMENTS:
_______________________________________________
Media enquiries:
Kelly du Plessis – CEO - Rare Diseases South Africa info@rarediseases.co.za · 072 623 6763
Alexi Rozenzweig – HJW Attorneys
Comments